Optimal cancer care pathways – the ideal versus reality for patient-centric cancer care during COVID-19.

Objectives: To assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19). Methods: This retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame. Results: There were n = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n = 479) of the cohort, followed by HN cancer patients (n = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P > 0.05). Conclusion: Despite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance. What is known about the topic? The Optimal Care Pathways are the only nationally endorsed guideline that provides key timeframes from diagnosis to commencement of treatment and beyond for 25 different tumour subtypes. What does the paper add? There is limited compliance throughout the entire care pathway, with limitations in data availability to benchmark the entire pathway. These compliance rates were not affected by COVID-19. What are the implications for practitioners? Adjustments should be made to incorporate the Optimal Care Pathways into cancer service performance, with robust data collection mechanisms, to ensure patients across Australia receive equitable cancer care. [ABSTRACT FROM AUTHOR]